Comparison of outcomes of infants between 30 weeks and 0 days to 31 weeks and 6 days of gestation at birth in Ontario based on the site/level of care
Dr. Prakesh S. Shah, MSc, MBBS, MD, DCH, MRCP, FRCPC
CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research
Director, Canadian Neonatal Network
Neonatologist and Clinical Epidemiologist, Mount Sinai Hospital
Professor, Departments of Paediatrics and Institute of HPME, University of Toronto
Fetal Fibronectin Testing in Ontario: Successful Government-Sector Collaboration to Achieve High-Quality and Sustainable System Change
Charlotte Moore Hepburn and Marilyn Booth
Ontario’s province-wide implementation of fetal fibronectin (fFn) technology, a test to identify women unlikely to deliver within two weeks of presentation with symptoms of preterm labour, is a notable example of evidence-informed system improvement and productive government-sector partnership. Increasing demand for costly, high-risk maternal and newborn care in Ontario hospitals prompted a provincial review. Sector experts identified potentially avoidable maternal admissions and transfers to high-risk units for evaluation of suspected preterm labour as an opportunity for system improvement. Limited access to fFn testing was documented, and expert consensus posited that funding rapid clinical testing to identify women at low risk for preterm delivery would yield a significant return on investment. An expert panel recommended evidence-based clinical guidelines. The government swiftly secured funding and initiated a successful implementation strategy, capitalizing on regional perinatal networks. Amassing clinical and care utilization information, framing the data in a policy-relevant context and partnering sector expertise with ministry capability resulted in this technology being effectively implemented in a complex health system.
Click here to read more: Healthcare Quarterly, 14 Special Issue(3) 2011: 90-94
Ontario’s Provincial Council for Maternal and Child Health: Building a Productive, System-Level, Change-Oriented Organization
Charlotte Moore Hepburn and Marilyn Booth
In the early 2000s, similar to many sectors in the current healthcare system (Ahmed et al. 2010; Breton et al. 2009; Plsek and Greenhalgh 2001), the maternal-child health sector in Ontario was fragmented, encumbered with redundant elements and challenged to deliver high-quality, efficient, cost-effective care. Acknowledging the strategic importance of the maternal-child health sector and recognizing the need to resolve this fragmentation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) created the Provincial Council for Maternal and Child Health (PCMCH; www.pcmch.on.ca) in late 2008. With a structure designed to engage the entire sector, together with the support of a dedicated secretariat, PCMCH was able to rapidly build momentum by unifying the maternal-child healthcare system and streamlining key elements of the organization and delivery of care (Day 2011; “New Bassinets = Better Access” 2011; Turner 2011). With an articulated function designed to focus on issues of mutual concern to the funder and provider, PCMCH has led to significant improvements in access, care quality and productivity (Moore Hepburn and Booth 2011; “SickKids Wins Celebrating Innovations in Health Care Award” 2011).
Click here to read more: Healthcare Quarterly, 15 Special Issue(4) 2012: 54-62.
Neonatal Abstinence Syndrome Clinical Practice Guidelines for Ontario
Kimberly Dow, Alice Ordean, Jodie Murphy, Jodie Pereira, Gideon Koren, Henry Roukema, Peter Selby, Ruth Turner
Ontario’s clinical practice guidelines for neonatal abstinence syndrome (NAS) provide evidence-informed recommendations that address the needs of substance using pregnant women and newborns at risk of NAS. NAS is a complex and multifaceted issue that is escalating along with rapidly rising opioid use in Ontario. Reducing the incidence and impact of NAS requires immediate action in order to improve the care of affected women and infants. This includes optimizing and standardizing treatment strategies, assessing and managing social risk, better monitoring of prescribing practices and facilitating the implementation of better treatment and prevention strategies as they become available. These clinical practice guidelines provide the framework to inform and support the development of a coordinated strategy to address this important issue and to promote safe and effective care.
Click here to read more: J Popul Ther Clin Pharmacol. 2012;19(3):e488-506. Epub 2012 Nov 23.